<br />
<p class="ErrorMessage" style="display: %%GLOBAL_HideFormError%%">
	%%LNG_BadContactFormCaptcha%%
</p>

<form action="%%GLOBAL_ShopPath%%/pages.php?action=sendContactForm" method="post" id="ContactForm" class="PL20">
	<input type="hidden" name="page_id" id="page_id" value="%%GLOBAL_PageId%%" />
	<div class="FormContainer HorizontalFormContainer">
		<dl>
			<dt style="display: %%GLOBAL_HideFullName%%">&nbsp;&nbsp; %%LNG_ContactName%%:</dt>
			<dd style="display: %%GLOBAL_HideFullName%%"><input type="text" name="contact_fullname" id="contact_fullname" class="Textbox Field200" value="%%GLOBAL_ContactName%%" /></dd>

			<dt><span class="Required">*</span>&nbsp; %%LNG_ContactEmail%%:</dt>
			<dd><input type="text" name="contact_email" id="contact_email" class="Textbox Field200" value="%%GLOBAL_ContactEmail%%" /></dd>

			<dt style="display: %%GLOBAL_HideCompanyName%%">&nbsp;&nbsp; %%LNG_ContactCompanyName%%:</dt>
			<dd style="display: %%GLOBAL_HideCompanyName%%"><input type="text" name="contact_companyname" id="contact_companyname" class="Textbox Field200" value="%%GLOBAL_ContactCompanyName%%" /></dd>

			<dt style="display: %%GLOBAL_HidePhone%%">&nbsp;&nbsp; %%LNG_ContactPhone%%:</dt>
			<dd style="display: %%GLOBAL_HidePhone%%"><input type="text" name="contact_phone" id="contact_phone" class="Textbox Field200" value="%%GLOBAL_ContactPhone%%" /></dd>

			<dt style="display: %%GLOBAL_HideOrderNo%%">&nbsp;&nbsp; %%LNG_ContactOrderNo%%:</dt>
			<dd style="display: %%GLOBAL_HideOrderNo%%"><input type="text" name="contact_orderno" id="contact_orderno" class="Textbox Field200" value="%%GLOBAL_ContactOrderNo%%" /></dd>

			<dt style="display: %%GLOBAL_HideRMANo%%">&nbsp;&nbsp; %%LNG_ContactRMANo%%:</dt>
			<dd style="display: %%GLOBAL_HideRMANo%%"><input type="text" name="contact_rma" id="contact_rma" class="Textbox Field200" value="%%GLOBAL_ContactRMA%%" /></dd>

			<dt><span class="Required">*</span>&nbsp; %%LNG_ContactQuestion%%:</dt>
			<dd><textarea name="contact_question" id="contact_question" class="Field300" rows="5" cols="50">%%GLOBAL_ContactQuestion%%</textarea><div id="SearchResults"></div></dd>

			<dt style="display: %%GLOBAL_HideCaptcha%%"><span class="Required">*</span>&nbsp; %%LNG_CaptchaVerification%%:</dt>
			<dd style="display: %%GLOBAL_HideCaptcha%%">
					<p class="Warning">%%LNG_CaptchaIntro%%</p>
					%%GLOBAL_CaptchaImage%%<br />
					<input style="margin-top:5px; width:105px" type="text" name="captcha" id="captcha" class="Textbox" />
			</dd>
		</dl>
		<p class="Submit">
			<input type="submit" value="%%LNG_SendForm%%" class="ContactButton" />
		</p>
	</div>
</form>

%%Panel.ContactFormJavaScript%%

%%GLOBAL_ARSPanel%%